Key Takeaway
A.B. Medical distinguished the denial form from the medical report. Read the 2007 ruling, correct report-request provision and related no-fault cases.
This article is part of our ongoing medical necessity coverage, with 191 published articles analyzing medical necessity issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
A denial form and the medical report supporting it are different documents. A.B. Medical Services v Liberty Mutual addressed what the denial form had to say. It did not give an insurer permission to change its medical theory without limit.
What changed in the A.B. Medical appeal
In A.B. Medical Services v Liberty Mutual, 39 AD3d 779 (2007), the Second Department rejected the Appellate Term’s requirement, insofar as its order imposed one, that an insurer include the medical rationale in the denial form itself.
The provider had made its initial showing for payment. The insurer raised a factual dispute over medical justification, so the provider was not entitled to summary judgment on the claim under review. The appellate court restored the Civil Court’s denial of that branch of the provider’s motion. It did not award summary judgment to the insurer.
The report-request provision
The regulation cited in A.B. Medical is 11 NYCRR 65-3.8(b)(4). The DFS text of Regulation 68 places the provision under subdivision (b).
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When an insurer bases its denial on a medical examination or peer review it requested, that provision requires release of the report upon a written request from the applicant, the applicant’s attorney or the treating physician. It does not state a separate 30-day response period for that report request or automatically require every item of background material a party might want.
A request for the report is also distinct from litigation discovery. The Medical Arts discovery decision concerns a court order directing responses during a pending summary-judgment motion.
Keep the denial and the proof separate
The absence of detailed medical reasoning on the NF-10 form was not enough to win A.B. Medical. Whether a submitted report proves lack of medical necessity remains a separate question. So does whether later testimony or a new medical theory falls within the preserved defense. This opinion does not decide every version of those disputes.
The phrase “four corners” can obscure that distinction. Start with the document being challenged: the denial form, the peer review, or the evidence offered in court.
Still current (September 2026): The DFS text of 11 NYCRR 65-3.8(b)(4) retains release of the insurer-requested medical report upon written request; A.B. Medical distinguishes that report from the denial form.
Last reviewed: September 2026.
Connect to the Encyclopedia
Start with the medical necessity and peer review hub.
- Discovery during a medical-necessity motion: Medical Arts
- An IME rebuttal that did not address the examiner: Eastern Star
- Missing justification for additional studies: Neomy
- Normal range of motion and an inadequate rebuttal: Mendoza
For review of a particular no-fault dispute, contact the firm with the denial and supporting medical papers.
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Medical Necessity Disputes in No-Fault Insurance
Medical necessity is the most common basis for no-fault claim denials in New York. Insurers hire peer reviewers to opine that treatment was not medically necessary, shifting the burden to providers and claimants to demonstrate otherwise. The legal standards for establishing and rebutting medical necessity — including the sufficiency of peer review reports, the qualifications of reviewing physicians, and the evidentiary burdens at arbitration and trial — are the subject of extensive case law. These articles provide detailed analysis of medical necessity litigation strategies and court decisions.
191 published articles in Medical Necessity
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a medical necessity matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
